Getting depression clinical practice guidelines right: time for change?
Study Goal
The researchers aimed to evaluate clinical practice guidelines for depression treatment, focusing on chronobiological interventions like light therapy.
Results Summary
Current guidelines tentatively support light therapy for seasonal affective disorder but lack sufficient evidence for non-seasonal depression. Recommendations are limited by the absence of reliable therapeutic markers for chronotherapeutics.
Population
Patients with seasonal affective disorder and non-seasonal depression.
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
agomelatine | no change | major depression | - | - | is considered as an option | #1 |
bright light therapy | no change | seasonal affective disorder | - | - | is considered as an option | #2 |
sleep deprivation | no change | - | - | - | is not routinely recommended | #3 |
light therapy | no change | seasonal depression | - | - | supports use | #4 |
chronotherapeutics | no change | non-seasonal depression | - | - | insufficient evidence to support reliance | #5 |
OBJECTIVE: As part of a series of papers ['Chronobiology of mood disorders' Malhi & Kuiper. Acta Psychiatr Scand 2013;128(Suppl. 444):2-15; and 'It's time we managed depression: The emerging role of chronobiology' Malhi et al. Acta Psychiatr Scand 2013;128(Suppl. 444):1] examining chronobiology in the context of depression, this article examines recent western clinical practice guidelines (CPGs) for the treatment of depression with respect to the recommendations they make, in particular as regards chronobiological treatments, and briefly considers the implications of their methodology and approach. METHOD: Five international treatment guidelines, which had been published in the past 5 years, were identified, representing North American and European views. Chosen guidelines were reviewed by the authors, and the relevant recommendations were distributed for discussion and subsequent synthesis. RESULTS: Most current guidelines do not address chronobiology in detail. Chronotherapeutic recommendations are tentative, although agomelatine is considered as an option for major depression and bright light therapy for seasonal affective disorder. Sleep deprivation is not routinely recommended. CONCLUSION: Recommendations are limited by the lack of reliable therapeutic markers for chronotherapeutics. Current evidence supports use of light therapy in seasonal depression, but in non-seasonal depression there is insufficient evidence to support reliance on chronotherapeutics over existing treatment modalities.